Trevor L. Macdowell, Wenrui Li, Kenneth Elmore, Ann M. Zaia, Judy T. Platt, Tom Rose, Katia Bulekova, Hannah E. Landsberg, Robert A. Brown, Lynn Doucette-Stamm, Candice Miller, Helen E. Jenkins, Tracy Schroeder, Eric D. Kolaczyk, Wayne Gilmore, Kelly Lockard, Davidson H. Hamer, Christopher J. Gill, Linette Decarie, Lena Landaverde, Douglas Densmore, Catherine M. Klapperich, Mark A. Faria, Gloria Waters, Laura F. White, Megan Pilkington, and Stephen P. Burgay
Key Points Question Can a multifaceted approach lead to control of COVID-19 transmission and spread on an urban campus? Findings In this case series including more than 500 000 COVID-19 tests and 719 individuals with COVID-19 at Boston University, active surveillance of campus populations, isolation of individuals with SARS-CoV-2 infection, early and vigorous contact tracing and quarantine, regular communication, robust data systems, and strong leadership were associated with minimal transmission of SARS-CoV-2. Most transmission occurred off campus, and there was no evidence of classroom transmission. Meaning These findings suggest that using frequent testing, vigorous contact tracing, rapid isolation and quarantine, and a strong leadership structure to ensure rapid decision-making and adaption to emerging data, controlling the spread of SARS-CoV-2 on an urban campus was feasible despite worsening local transmission during the semester., This case series describes the use of a multifaceted COVID-19 control plan to reduce spread of SARS-CoV-2 at a large urban university during the second wave of the pandemic., Importance The COVID-19 pandemic has severely disrupted US educational institutions. Given potential adverse financial and psychosocial effects of campus closures, many institutions developed strategies to reopen campuses in the fall 2020 semester despite the ongoing threat of COVID-19. However, many institutions opted to have limited campus reopening to minimize potential risk of spread of SARS-CoV-2. Objective To analyze how Boston University (BU) fully reopened its campus in the fall of 2020 and controlled COVID-19 transmission despite worsening transmission in Boston, Massachusetts. Design, Setting, and Participants This multifaceted intervention case series was conducted at a large urban university campus in Boston, Massachusetts, during the fall 2020 semester. The BU response included a high-throughput SARS-CoV-2 polymerase chain reaction testing facility with capacity to deliver results in less than 24 hours; routine asymptomatic screening for COVID-19; daily health attestations; adherence monitoring and feedback; robust contact tracing, quarantine, and isolation in on-campus facilities; face mask use; enhanced hand hygiene; social distancing recommendations; dedensification of classrooms and public places; and enhancement of all building air systems. Data were analyzed from December 20, 2020, to January 31, 2021. Main Outcomes and Measures SARS-CoV-2 diagnosis confirmed by reverse transcription–polymerase chain reaction of anterior nares specimens and sources of transmission, as determined through contact tracing. Results Between August and December 2020, BU conducted more than 500 000 COVID-19 tests and identified 719 individuals with COVID-19, including 496 students (69.0%), 11 faculty (1.5%), and 212 staff (29.5%). Overall, 718 individuals, or 1.8% of the BU community, had test results positive for SARS-CoV-2. Of 837 close contacts traced, 86 individuals (10.3%) had test results positive for COVID-19. BU contact tracers identified a source of transmission for 370 individuals (51.5%), with 206 individuals (55.7%) identifying a non-BU source. Among 5 faculty and 84 staff with SARS-CoV-2 with a known source of infection, most reported a transmission source outside of BU (all 5 faculty members [100%] and 67 staff members [79.8%]). A BU source was identified by 108 of 183 undergraduate students with SARS-CoV-2 (59.0%) and 39 of 98 graduate students with SARS-CoV-2 (39.8%); notably, no transmission was traced to a classroom setting. Conclusions and Relevance In this case series of COVID-19 transmission, BU used a coordinated strategy of testing, contact tracing, isolation, and quarantine, with robust management and oversight, to control COVID-19 transmission in an urban university setting.